T86.22
T86.22: Heart transplant failure
Billable / specific codeICD-10-CM
T86.22 is a billable, specific ICD-10-CM code for heart transplant failure. It is valid for submission on a claim.
Check T86.22 with the rest of the claim: free scrubberOther codes that can never be billed with T86.22
Their own Excludes1 notes name this code, so the conflict is not listed above.
- Z98.85Transplanted organ removal status
Risk adjustment
T86.22 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 221 Heart Transplant Status/Complications1.053 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
T86.22 is named in 24 Medicare coverage policies: 24 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A52466Nebulizers - Policy Article
- A52474Immunosuppressive Drugs - Policy Article
- A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
- A55639Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions
Alphabetic index entries that lead here
- Failure, failed›transplant›heart
- Complication›transplant›heart›failure
The condition this code belongs to
Code history
Unchanged in every release from FY2024 to FY2027.